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Net Pricing Request

Submit one Net Pricing Request form per branch location.

Required fields are indicated with an asterisk ( * ) and must be completed before your request can be accepted. Requests will be reviewed by your rep. When verified, the Net Pricing will be sent to you via the method specified. Submission of this form constitutes a single–event request and does not automatically generate requests for any future price increases.

Electical Distributor Information
* Company  
* Contact  
Address (cont.)  
* City  
* State  
* Branch Location City / State  
Account Number  
* Phone  
* Email  

Terms and Conditions

This quotation is based on information supplied to Milbank of which the validity is not known or confirmed. Therefore it is the customer's responsibility to review the quotation for compliance and accuracy.

By submitting this request, I put forth that I am authorized by my company to receive this Milbank proprietary information. I understand that this information is the intellectual property of Milbank Manufacturing and is not to be distributed outside of my company's authorized personnel.

* Who' s your local manufacturer' s rep?